Ask Dr. H: Harm steroids, other drugs can do to athletes

Posted: August 07, 2012

Question: With all the recent attention paid to athletes over illegal steroid drug use, I've been wondering what harm these drugs actually do. Can you explain?

Answer: There are a number of performance-enhancing drugs with different effects and safety concerns.

The most common performance-enhancing drugs are derivatives of testosterone, such as androstenediol, DHEA, hCG (the same hormone used to detect pregnancy), THG, oxandrolone and stanozolol. They are well-known to increase muscle bulk and strength. Side effects include raising cholesterol (increases risk of heart disease); raising blood sugar sufficient to cause prediabetes or frank diabetes; testicular atrophy and impotence; mania, aggression, frequent emotional reactions, and mood swings; and a marked increased risk of tendon rupture.

Stimulants are used by some athletes to increase energy and help with weight loss. Side effects include high blood pressure; stroke; life-threatening heart rhythm disturbances; heart attack; and seizures. The stimulant ephedra is now banned by the FDA.

Drugs that stimulate red blood cell production can increase oxygen-carrying capacity and greatly aid endurance athletes such as long-distance runners, cyclists, skiers, and soccer and basketball players. Health risks might include an increased risk of clots and heart failure.

Insulin injections have been used by weightlifters to block the breakdown of muscle cells. Even though they typically drink sugared drinks after injection, severe low blood sugars resulting in seizures can still occur.

Creatine powder is widely used to increase strength and endurance. Studies have shown creatine causes muscles to bulk up due to water retention, with only a modest improvement in muscle strength. Creatine is not a banned substance, but might be laced with something that is illegal.

Some may argue that performance-enhancing drugs enable athletes to play at a higher level, creating better entertainment for fans. I disagree. They put the athlete in harm's way and detract from the purity of the sport.

Cranberries as a remedy

Q: I've been told by my new doctor to drink cranberry juice to help prevent the frequent urinary tract infections I get. Does it really help? Is it better than taking a daily antibiotic for prevention?

A: Cranberry juice/extract has been a folk remedy for both preventing and treating urinary tract infections (UTIs) for many years. Curiously enough, it does seem to help.

We used to think that it was the acidity of cranberry juice (or cranberry extract in the form of capsules) that inhibited the growth of bacteria in the bladder. While that may have some role in preventing and treating bladder infections, the main mechanism by which cranberry juice or extract helps is D-mannose, a naturally occurring sugar in cranberry juice. D-mannose is filtered by the kidneys and excreted into the urine. It so happens that bacteria preferentially bind to D-mannose instead of the bladder's wall. D-mannose removes harmful bacteria from the urinary tract by blocking its attachment to the bladder and thereby allowing its excretion.

Is there evidence? Issue 2 of the 2004 Cochrane Library published an analysis of seven properly designed studies evaluating cranberry juice for the prevention of urinary tract infections. Their conclusion was that it did seem to help, but insufficient data exists in the elderly and in children. My observation is that cranberry extract is more effective than juice/cocktail.

A recent Dutch head-to-head study compared cranberry extract against the antibiotic Bactrim in preventing UTIs. Whereas cranberry extract recipients had fewer UTIs than the preceding year (4 versus 6-7), the Bactrim-treated group fared better (1.8 UTIs versus 6-7). However, antibiotic resistance to E. coli bacteria developed in 85 percent of people taking Bactrim. That's a big long-term advantage to using cranberry extract.

Another option might be to try D-mannose in the form of a daily supplement. You should be able to find it either online or at a health food store.


Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.

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